18 Munroe Street, Napier, New Zealand 4110
Ph 06 835 0031
Fax 06 835 1452
Office Hours:Mon - Thurs 9am-4:30pmFri 9am-3:00pm
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First Name (required)
Last Name (required)
Work Phone Number
Mobile Phone Number
Current Address (required)
Date of Birth (dd/mm/yy) (required)
What address is this application for?
How Long Have You Lived at Current Address?
Why Are You Leaving?
Number of Bedrooms Required?
1 Bedroom2 Bedrooms3 Bedrooms4 Bedrooms
Maximum Rent ($)
Total Number of People Intending to Reside there?
Do you Need to Give Three Weeks Notice?YesNo
Latest Date Property Required? (dd/mm/yy)
Address of Employer
Phone Number of Employer
Motor Vehicle Make
Motor Vehicle Model
Motor Vehicle Registration Number
Do You Have a Pet?
If Yes, What is the Pet?
Next of Kin?
Relationship of Kin to You
Address of Next of Kin
Phone Number of Next of Kin
Driver's License Number
I AGREE to You Contacting Any of these Referees
Landlord Reference Name 1
Landlord Reference Phone 1
Landlord Reference Name 2
Landlord Reference Phone 2
I consent to Jim Brown Rentals making such enquiries, as they feel necessary to process this application, which may include a credit check. I agree that should I take up a tenancy of any property introduced to me by Jim Brown Rentals I will pay Jim Brown Rentals a fee equivalent to ONE WEEKS RENT PLUS GST. This application is kept for one month only unless we have further contact with you
I Consent to Jim Brown Rentals to Make Enquiries
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